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Angiography is the gold standard exam for all vascular diseases. In neurointervention is fundamental the angiographic study. MRI, Doppler can be very helpful. However Angiographic study can show a huge quantity of information and can change the way that I will treat some lesions. I am wrong?

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Access thru the femoral vein and up to the azygos and jugular veins, or venoplasty, is the gold standard in CCSVI testing and intravascular ultrasound (IVUS), provides the most complete information. But Dr. Zamboni's non-invasive doppler protocol provides much information without entering the body.

When I was treated, the doppler ultrasound was done first to give a diagnosis, which satisfies the insurance company so that we can then go for the full angiography and angioplasty.

I do not think any information is gained from either the doppler or MRV that is not better seen on angiography. If the IR is not entering the dural sinuses, then the sinuses might need separate MRI imaging if there is reason to believe that the sinuses are malformed or thrombosed.

In other words, you are right, except that it has been suggested that it is angiography plus intravascular ultrasound that together are the gold standard for CCSVI.

I have to say that I have heard of numerous people here in Australia who have been tested for CCSVI using Doppler analysis. The Doppler study indicated no CCSVI was present (and the analyst is quite experienced, trained remotely in the Zamboni Doppler protocol). Each party was fortunate enough to access an IR willing to do a venogram to find out what was really going on. You guessed it - in each case the patient had CCSVI (and the occlusion was in an awkward locale).

So what's going on? Was the Doppler ultrasound substandard - or is it a simple fact that you'll see more by venogram? Zamboni himself has commented that MS patients have CCSVI if they have two or more "positive" tests during the Doppler ultrasound...but the same two tests cannot be relied upon for the entire CCSVI patient population.

Myself - I had a pretty nasty stenosis in my right internal jugular (valve region) which was so clear on the MRV...but was not so clear in the venogram. Of course, I could feel it and pinpoint the exact location. Took the IR three venograms to be able to see what I could point to with my finger. By the third occassion, he was using the Doppler studies, and the MRV in conjunction with his venogram. And he asked me what my symptoms were

I told him the right side of my head felt like it was in a vice, and i had the "classic" internal jugular pressure on my jaw.

I reckon the patient is an under-utilised resource in the diagnosis of CCSVI.

cheerleader wrote:Access thru the femoral vein and up to the azygos and jugular veins, or venoplasty, is the gold standard in CCSVI testing and intravascular ultrasound (IVUS), provides the most complete information. But Dr. Zamboni's non-invasive doppler protocol provides much information without entering the body.

Just one thing. I think we should make a difference about a generic hampered venous drainage (CCSVI) and venous lesions that cause CCSVI. Zamboni defined CCSVI as "hampered cerebrospinal venous drainage" (in the article "chronic cerebrospinal venous insufficiency in patients with multiple sclerosis") and nobody has ever proven that venous lesions are the only cause for this (I am thinking about CTOS).

IVUS and venographies are the gold standard for detecting venous lesions, but Doppler can detect venous drainage problems regardless of its cause.

Yes and no- doppler is best for imaging jugular malformations, since it can see the interior of the actual vein. Transcranial doppler can indicate deep cerebral vein reflux and doppler can indicate azygos reflux, by showing flow, but dopper doesn't actually image the lining of those veins. It's fortunate the vascular doctors have so many scanning modalities...but obviously, it can be confusing.cheer

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